Application for Service

Need power turned on at a location served by Southwest Rural Electric Cooperative? Please complete the below form to apply for service. A $5.00 membership fee and a $20.00 connect fee are required from all applicants. A $300.00 deposit may also be required. Once your account is created in our system, you will receive an email, which includes the total amount due. Service will not be connected until all deposit requirements are met. All requests for service will be performed during normal business hours. If you have any questions regarding new service, please feel free to contact our office during normal business hours 1-800-256-7973.  

Note: All fields with the asterisk (*) are required.


Today's Date:  
Date Service is Desired:  *  
Type of Request:  *
First Name:   *
Last Name:   *
Social Security Number:-  -   *
Date of Birth:  *
Employed By:  
Work Address:  

Mailing Address:
Street Address/P.O. Box:  
City: 
State: 
Zip Code:  

Service Address:
Service Address:  
Meter Number:  
Comments:  
E-mail:  *
Confirm E-mail:  *
Home Phone:-  -    *
Cell Phone:-  -   
Work Phone:-  -     
Spouse's Name: 
Spouse Social Security #:-  -   
Date of Birth:  
Employed By:  
Work Address:  

Online Account Access:
As one of our services, we provide an online portal for account management and viewing and paying bills. If you'd like to use this service, please specify an Internet Password and Password Hint at this time. Please note, for security purposes, your Internet Password must be a combination of letters and numbers.

Internet Password:  
Confirm Internet Password:  
Password Hint:

Existing or Previous Service:
Have you ever had service with us before?
    
Account Number:
Fee and Depsoit Information:
If you are not currently a member of SWRE, a $5.00 Membership Fee will be required to join - this fee will be refunded or applied to your final bill should you have the location disconnected or move out of our service territory. A refundable** deposit of $300.00 is required at the requested location. Fee may be waived for members with letters of good credit from previous utility companies or a base waiver from AFB.

**Your account will be reviewed after 12 months of continuous service. If the account has been kept current during the period of review, your deposit will be refunded to you at that time. If the account has been delinquent at any time during the 12 month period, your deposit will not be refunded until your account is closed.


Membership Fee:  
Deposit:  
Connect Fee:  

Nearest Relative:  *
Relationship:  *
Phone Number:  *
Address:  *
Previous Utility:  *
City, State:  *
Status at service location:  *
Please select your preferred billing method:  *
 
The undersigned, hereinafter called the “applicant”, hereby applies for membership in, and agrees to purchase electric energy from Southwest Rural Electric Association, Inc., a corporation, hereinafter called the “Association”, upon the following terms and conditions.  THIS APPLICANT HEREBY CERTIFIES THAT THE INFORMATION PROVIDED IS CORRECT AND AUTHORIZES THE COOPERATIVE TO SEEK PAST CREDIT HISTORY AND TO RELEASE CREDIT HISTORY FOR FUTURE INQUIRIES.
I understand that checking this box and typing my name in the field provided below is my electronic signature.
  Applicant Name:     *